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Paul Kadetz and Johanna Hood

Foreign aid directed toward the health sector, or health diplomacy, is a form of soft power that ultimately may assist with the fulfilment of the foreign policy goals of the donor country. China’s health aid to African States (which spans more than half a century) seeks to offer an alternative to normative western aid in its discourse of mutually sustainable self-development and historically in its more horizontal approach to health care. This research, based on a review of the literature and semi-structured interviews conducted at the Third International Roundtable for China–Africa Health Cooperation in Beijing, and with pertinent stakeholders in Antananarivo, Madagascar, aims to identify the actual sustainable self-development being fostered by Sino-African health diplomacy. Regardless of the horizontal structure of China’s health aid to African contexts, the foreign policy development discourse emanating from Beijing and the work of thousands of Chinese in African States since the mid-1960s, this research finds that Chinese health aid to Madagascar, as with western health aid, has resulted in a fragmented health care system – and, ultimately, an increased dependency on foreign aid – rather than in the growth of sustainable self-development.

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Tony Saich

Policy development is analyzed in light of two key factors: changing support for core groups, and how the leadership assesses and responds to perceived risk. This framework is used to understand the political economy of welfare reform in China, and how policy has been used to consolidate and perpetuate State, in reality Chinese Communist Party (CCP), power. In so doing the chapter raises the question of whether welfare policy is becoming more inclusive. We outline a four-period categorization of welfare policy since 1949. The reforms introduced after 1980, combined with policy neglect and a naïve faith in the market, led to a breakdown of the workplace-based system established after 1949. The initial response (1996–2002) centered on shoring up support within urban China, despite the dramatic impact policy had on those living in rural China. A more inclusive approach has been taken since 2002, both in terms of support for those in the countryside and for the rapidly expanding numbers of migrant workers. While China’s welfare system shares certain features with other Asian polities, there is no single system for public service delivery, and the outcomes are marked by greater inequalities of service provision. We conclude that while recent policy trends indicate moves towards a welfare system based on the notion of citizenship, a welfare policy based on this alone remains far off: migrants are still significantly disadvantaged, as are those who remain in the countryside. Urban bias remains strong, and government officials and party workers remain a privileged elite.

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Juan Chen

In light of the rapid urbanization process and the associated social and welfare reforms in China since the 21st century, this chapter examines rural-to urban migrants’ access to urban social services and integration into various aspects of urban life, based on analysis of the 2011 Migration and Quality of Life Survey data. Results present a mixed picture: in the areas of occupation, industry, health status and receipt of medical treatment, rural-to-urban migrants did not face more discrimination than urban residents; neither did they report higher levels of perceived institutional or interpersonal discrimination. However, they were still excluded from jobs in the State sector, and their identity was closely linked to their rural background. Nonetheless, rural-to-urban migrants did not show a lesser degree of involvement in urban community activities or a greater inclination to move out of their host city than urban residents or urbanized rural residents after socio-demographic characteristics, particularly homeownership, were controlled in the analysis. Given that rural-to-urban migrants represent a significant proportion of the urban population but have not enjoyed the same citizenship rights of urban dwellers, such an investigation provides essential insights for improving the efficacy of social and welfare reforms in China. Particularly, ongoing pro-urbanization policies must be accompanied by measures to grant rural-to-urban migrants equal access to jobs in the State sector; to urban health insurance and medical services; and to stable and affordable housing in the host cities.

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Reza Hasmath and Andrew W. MacDonald

The social welfare of ethnic minorities is a contested subject in contemporary China, with a deep politicalised history. This chapter introduces the slate of policies that the Chinese government has enacted to benefit minorities, with particular attention on the Minimum Livelihood Guarantee programme, the dibao. We find that the dibao has generally been pro-minority, while other new social programmes – even conditional on need – still tend to favour Han residents.

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Mark W. Frazier and Yimin Li

It is commonly said that China will ‘grow old before it grows rich.’ This has become a shorthand way of predicting that China, as a developing country, lacks the resources necessary to support an ageing population. But this truism overlooks an important development that might well alleviate the challenges of an ageing population: China is urbanizing rapidly as it grows old. This chapter examines the literature on China’s demographic change and the possible effects on China’s economic growth and social institutions, among other far-reaching consequences. China’s demographic transformation is inevitable, but the effects of this transformation are not. A shrinking labour force means an expanding elderly population will not, in and of itself, drag China’s economy into long-term stagnation. Instead, the effects of ageing will hinge on other factors, such as productivity growth and urbanization. The central argument of this chapter is that urbanization holds out the possibilities of reducing the status and income divides between urban and rural citizens. Bringing pension rights to rural residents, and at levels commensurate to those now enjoyed by the urban population, will create new streams of both fiscal and political support for the nascent pension and healthcare systems. Broad-based inclusion of the population in these programs would mitigate the fiscal challenges posed by population ageing.

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Dorothy J. Solinger

This chapter presents an outline of the Minimum Livelihood Guarantee program (dibao), a social assistance scheme first introduced in Shanghai in 1993 and expanded to all Chinese cities by 1999. The chapter argues that the scheme has been tightly linked to the pacification of laid-off workers (primarily those from the State-owned sector). It was designed also to serve as a new form of basic sustenance for the poor following the collapse of the welfare safety net provided by the traditional urban work unit under the socialist planned economy. The chapter argues accordingly that as public demonstrations by the jobless fizzled out after the mid-2000s, the initial relative generosity of the early phase of the scheme saw declining benefits over time. The chapter uses statistical comparisons to document the increasing miserliness of the scheme: i.e., it compares dibao outlays with average disposable income of urban residents nationwide and with average wages in various cities; and it considers drops in governmental dibao investment as a percentage of gross domestic product and of government expenditure over the years. Finally, the chapter draws on interviews with recipients to convey the pitiable living conditions under which these allowances force them to survive.

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Kimiko Suda

The precarious housing and working situation of rural-to-urban migrant graduates (vocational college or university education) – colloquially known as the ‘ant tribe’ – has been discussed in China´s public media since the first two reports on this social group were published by the Beijing-based scholar Lian Si in 2009 and 2010. Against the background of current Chinese debates on the distribution of urban public resources and social injustice, this chapter presents a localised picture of the welfare access of migrant graduates in the southern city of Guangzhou. It investigates different factors (e.g. household registration and human and social capital) affecting migrant graduates’ access to urban employment and to the urban social insurance system. It further examines how they cope with the lack of access to welfare, and concludes by putting forward some policy suggestions to increase the level of access to welfare services for this social group.

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Thomas David DuBois

This chapter examines the roots of public welfare in China, spanning the crucial 100 years before the 1949 founding of the People’s Republic, and highlighting the political importance of welfare provision across a range of very different Chinese regimes. Rather than attempting to map the contemporary Western understanding of welfare onto history, it presents Chinese ideas and institutions on their own terms. During the late nineteenth century, well-established traditions of State and private charity provision began to transform in the face of new pressures and opportunities, including the arrival of Christian missionary institutions. In the early twentieth century, China was divided into a number of regimes, including the Republic of China, the Communist-held areas and the Japanese client regime in Manchuria. This political fragmentation caused the welfare tradition to diversify into a number of competing ideologies and strategies. The transformation of welfare provision during this century was driven by a number of interrelated processes: the growing influence of foreign actors and institutions; the formation of legal and legislative frameworks for the rights and responsibilities of welfare providers; and the shift in balance between private and State initiative, and between disaster relief and longer-term programmes of economic development. This history continues to tangibly shape contemporary political and social attitudes towards welfare provision.